U.S. patent application number 16/755014 was filed with the patent office on 2020-11-05 for ex vivo lung simulator.
The applicant listed for this patent is XVIVO PERFUSION AB. Invention is credited to Emur JENSEN.
Application Number | 20200349863 16/755014 |
Document ID | / |
Family ID | 1000004985547 |
Filed Date | 2020-11-05 |
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United States Patent
Application |
20200349863 |
Kind Code |
A1 |
JENSEN; Emur |
November 5, 2020 |
EX VIVO LUNG SIMULATOR
Abstract
The present invention relates to methods and devices to simulate
lung perfusion and or ventilation for training or development of
lung related equipment.
Inventors: |
JENSEN; Emur; (Denver,
CO) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
XVIVO PERFUSION AB |
Goteborg |
|
SE |
|
|
Family ID: |
1000004985547 |
Appl. No.: |
16/755014 |
Filed: |
February 3, 2017 |
PCT Filed: |
February 3, 2017 |
PCT NO: |
PCT/EP2017/052325 |
371 Date: |
April 9, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62291036 |
Feb 4, 2016 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
G09B 23/285
20130101 |
International
Class: |
G09B 23/28 20060101
G09B023/28 |
Claims
1. A lung simulator device, the device comprising an oxygenator, at
least one inflatable reservoir, and tubing for ventilating and
perfusing the device.
2. The device according to claim 1, wherein the device is connected
to an external pump, a ventilator and monitoring equipment.
3. The device according to claim 2, wherein the device comprises
EVLP equipment.
4. The device according to claim 1, wherein the device has two
inflatable reservoirs.
5. The device according to claim 1, wherein the oxygenator is a
permeable membrane oxygenator.
6. The device according to claim 1, wherein the tubing for
perfusing the device comprises an arterial inlet and a venous
outlet connected to the oxygenator.
7. The device according to claim 1, wherein the tubing for
ventilating the device is connected from a ventilator to at least
one inflatable reservoir via the oxygenator.
8. (canceled)
9. A method of simulating a lung, the method comprising the steps
of: providing a lung simulator device, the device comprising an
oxygenator, at least one inflatable reservoir, and tubing for
ventilating and perfusing the device; passing air into the device
through the tubing to ventilate the inflatable reservoir and
contact the oxygenator; passing perfusate through the tubing to
contact the oxygenator, wherein gas exchange occurs between the air
and the perfusate in the oxygenator; and measuring one or more
parameters of the perfusate and/or air.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to products and methods for
simulating isolated lung perfusion. These products and methods can
be used for training on lung perfusion or for development of new
lung perfusion devices.
BACKGROUND TO THE INVENTION
[0002] Ex Vivo Lung Perfusion (EVLP) has become an accepted
clinical procedure that can safely increase the number of available
lungs for transplantation. The procedure involves pumping a
perfusate through the vasculature of a lung with unknown function,
outside the body, before the lung is selected or deselected for
transplantation. Furthermore it involves ventilation of the lung.
The circulation/ventilation circuit connected to the lung during
EVLP is used to assess oxygenation capacity, pulmonary vascular
resistance (PVR), and lung compliance etc. The Perfusate might be
STEEN Solution (as described in WO2002/35929) or another solution
appropriate for organ perfusion.
[0003] Although EVLP has become clinically accepted, the number of
procedures is relatively few, less than 250 each year, spread out
over about 30 clinics across the world. Most clinics that practise
EVLP do fewer than 10 procedures annually. The low number of
procedures causes an uncertainty and unfamiliarity of how to
perform the procedure, which in turn further decreases the number
of procedures performed. The result is patients dying waiting for
lungs because they do not access the possibility of receiving lungs
after EVLP. With more frequent training of the clinicians involved
in EVLP a higher confidence level for the procedure occurs and more
EVLP procedures will be performed.
[0004] Training on EVLP requires utilization of research/training
lungs either of human or animal origin. Most often pig lungs are
used, due to the anatomical similarities between human and pig
lungs. However, both sources of lungs includes ethical
considerations. It is desirable to find a way to improve the access
of patients to lungs that have been through the EVLP procedure.
[0005] Lung simulators exists for training of in vivo use of
ventilators. An example of an in vivo test lung is the Michigan
lung from Michigan Instruments. These lung simulators do not
circulate any perfusate fluid. Therefore oxygenation parameters,
flow resistance and all other perfusate parameters important for an
EVLP procedure cannot be monitored, hence they could not be used to
train or develop an EVLP system.
SUMMARY OF THE INVENTION
[0006] According to a first aspect, the present invention provides
a lung simulator device, the device comprising an oxygenator, at
least one inflatable reservoir, and tubing for ventilating and
perfusing the device. The oxygenator is preferably a membrane
oxygenator. There are preferably two inflatable air reservoirs and
cannulation for perfusate flow through the device.
[0007] Accordingly the current invention comprises a lung simulator
which is completely without material derived from animal origin,
and which could be repeatedly used as a training lung. This
non-animal derived development and training lung diminishes the
ethical considerations concerned with using a human or animal lung
and reduces costs per procedure, thereby allowing for more frequent
training sessions, which in turn would increase the utilization of
EVLP and therefore the number of lung transplantations, ultimately
leading to better outcomes for patients.
[0008] In use, the lung simulator is perfused with a perfusate and
ventilated by an external ventilator, as during a conventional EVLP
with a human or animal derived lung. Furthermore, perfusate and
ventilation parameters could be monitored, providing a real
training experience, without sacrificing an animal or use of a
human lung.
[0009] Furthermore, the device could be used during development of
EVLP equipment or other lung devices.
[0010] According to a second aspect, the present invention relates
to the use of a lung according to the first aspect of the
invention, to train clinicians in the use of a lung related medical
device or in the development of a lung related medical device.
[0011] According to a third aspect, the present invention relates
to a method of simulating a lung, the method comprising the steps
of: providing a lung simulator device according to the first aspect
of the present invention; passing air into the device through the
tubing to ventilate the inflatable reservoir and contact the
oxygenator; and passing perfusate through the tubing to contact the
oxygenator; wherein gas exchange occurs between the air and the
perfusate in the oxygenator; and measuring one or more parameters
of the perfusate and/or air.
BRIEF DESCRIPTION OF THE DRAWINGS
[0012] FIG. 1 is a flow diagram of one preferred set-up of the lung
simulator according to the present invention.
DESCRIPTION
[0013] The utilization of animal or human lungs for EVLP training
could be expensive and always involves ethical considerations.
Human discarded lungs have the additional issue of availability
when required. It is quite impossible to plan for a training
session with a donated discarded human lung. Pig lungs are
available upon planning, but killing an animal for training is
ethically difficult and requires ethical permission at the
institution. Furthermore, it is questionable to use lungs from
animals on a device intended for human clinical use. Although all
parts of the device that come in direct contact with the lung are
disposable, there is still a theoretical risk involved with using a
human device for animal procedures and this is often not in line
with approved institutional procedures.
[0014] In contrast, the lung simulator of the present invention is
always available, re-usable, inexpensive and without ethical
considerations. This allow the surgeons, perfusionists and others
involved in the procedure to train on the EVLP procedure at any
convenient time and as often as is needed to build and maintain
confidence in the knowledge of how to perform the procedure.
Confidence in the ability of clinicians to perform a task increases
their willingness to perform it and the burden of initiating a
procedure is reduced once the confidence level of the clinician is
sufficiently high.
[0015] One reason why many centers perform relatively few EVLP
procedures, even though they have access to the EVLP technology, is
lack of confidence in their ability to perform it. The fewer EVLPs
that are being done, the higher is the hurdle to do an EVLP. As
EVLP has been shown to increase the number of transplantations
being performed at a clinic by at least 30%, the non-use of EVLP
leads directly to missed opportunities for patients to receive lung
transplants. Some of these patients will die waiting for lungs.
Accordingly, regular training with the lung simulator of the
present invention could avoid some of these deaths.
Device Description for Ex-Vivo Lung Simulator
[0016] With reference to FIG. 1, the device 1 comprises a lung
simulator which comprises an oxygenator 2, at least one inflatable
reservoir 3, and tubing. It can therefore be constructed completely
without material derived from animal origin, and is not dependent
on use of a donated human or animal lung. The device of the present
invention can be repeatedly used as a training lung. The lung
simulator comprises an oxygenator, preferably a membrane
oxygenator, at least one, preferably two, inflatable air reservoirs
and cannulation for perfusate flow through the device.
[0017] The oxygenator 2 in the device of the present invention is
preferably a permeable membrane oxygenator. An example of a
suitable device is the Maquet Quadrox-i Hollow Fiber
Oxygenator.
[0018] The lung simulator 1 includes at least one, and preferably
two inflatable reservoirs 3. The inflatable air reservoir(s) 3 are
used to collect, hold and exhale the ventilated air simulating
airway resistance. Any suitable reservoirs can be used, such as
Hamilton Medical 2.0 L Breathing Bag.
[0019] The lung simulator of the present invention also comprises
tubing for ventilating and perfusing the device. An example of the
flow paths is shown in FIG. 1. The tubing for ventilating the
device 4 is typically connected to a ventilator (not shown) via a
tracheal tube connector, which allows inspired and expired air to
be analysed. The ventilation tubing 4 connects the ventilator with
at least one of the inflatable reservoirs 3 via the oxygenator 2,
so that air passes from the ventilator, through the oxygenator 2,
and into the inflatable air reservoir 3 during the inspiratory
cycle of the ventilator. Air is then held in the reservoir 3 before
being passed out of the reservoir, and back though the oxygenator 2
during the expiatory cycle of the ventilator. FIG. 1 shows the
ventilator connection with air inhaled 5 that typically has a high
O2 and low CO2 going into the device, and air exhaled 6 which
typically has a low O2 and high CO2 coming out of the device. The
air goes directly in and out of one of the inflatable air
reservoirs 3, and goes in and out of the other inflatable air
reservoir 3 via the oxygenator 2.
[0020] The tubing for perfusing the device comprises an arterial
inlet and a venous outlet connected to the oxygenator. As shown in
FIG. 1, there is preferably a pulmonary artery cannula connection 7
for the perfusate or blood inlet (which is typically low 02 and
high CO2 9) and a left atrium cannula connection 8 for the
perfusate/blood outlet (that is typically high 02 and low CO2 10).
The inlet and/or outlet is connected to an external pump (not
shown) to pump the perfusate through the oxygenator 2.
[0021] In the oxygenator 2 the perfusate and air come into contact
via a membrane (not shown) which allows gas exchange to occur. As
shown in FIG. 1 this can be a permeable membrane oxygenator.
[0022] During use air is ventilated by an external ventilator
connected to the lung simulator 1 via a normal tracheal tube
connector 4 allowing ventilator parameters to be analysed. An
arterial inlet 7 and a venous outlet 8 for the perfusate is
connected to the membrane oxygenator 2, allowing perfusate
parameters to be analysed.
[0023] This device is intended to be used as a lung simulator for
ex-vivo lung perfusion systems. The device is designed to allow
perfusate, blood, or mixture thereof to flow through the system as
the device is ventilated via external ventilation system. Gas
exchange between airway and perfusate is to occur as in a
biological lung. Response parameters from both the perfusate and
airway are intended to physiologically resemble that of a
biological lung.
[0024] The device of the present invention preferably includes
monitoring equipment (not shown) which can measure over time
parameters of the perfusate and/or air before entering and/or after
leaving the lung simulator device. In particular, the active and
responding parameters that can be measured and monitored over time
may comprises some or all of the following:
Perfusate (Blood Path)
[0025] Flowrate [0026] Pressure (pulmonary artery and left atrium)
[0027] Temperature (pulmonary artery and left atrium) [0028] PVR
(Pulmonary Vascular Restriction) [0029] Blood gas concentrations
(pulmonary artery and left atrium)
Airway
[0029] [0030] Tidal Volume [0031] Peak Pressure [0032] PEEP
(positive end-expiatory pressure) [0033] Breathing Rate (Breaths
per Minute) [0034] Inspiratory to Expiratory Ratio [0035] Oxygen
Concentration [0036] Compliance
Uses
[0037] The device is intended to be used for training medical staff
on EVLP procedures with EVLP systems. The EVLP system comprises for
example the XPS.TM. from XVIVO Perfusion, the LS1 and LS2 system
from Vivo line and the OCS from Transmedics, or any other
commercial or home-made system can be used.
[0038] The simulator lung can also be used as a development tool
for designing and optimizing EVLP systems or other medical devices
to be used on lung(s) and as a demonstration and academic tool for
ex vivo surgical lung procedures.
[0039] The simulator lung could be used with perfusates used in
clinical EVLP such as STEEN Solution.TM., available from XVIVO
Perfusion AB, but it could also be used with any other solution.
For example the simulator lung could be perfused with water. This
is an additional advantage as use of water or other cheaper
solutions reduces the cost of the training procedure even more.
Method of Operation
[0040] Perfusate is pumped through the lung simulator via external
pumping equipment.
[0041] Air is delivered into the lung simulator during the
inspiratory cycle of respiratory ventilator. Air is pushed back
from the lung simulator to ventilator during the expiatory cycle of
ventilator.
[0042] Gas exchange occurs inside the lung simulator via permeable
membrane.
[0043] Instrumentation external to simulator is used to measure
EVLP parameters.
Example
[0044] A test run was performed using the lung simulator device
with the XPS.TM. system. Water was used as the perfusate. The EVLP
cycle was run according to standard protocol for the XPS.TM.. The
EVLP cycle lasted for five hours.
[0045] The following parameters were set on the EVLP equipment
ventilator and perfusing pump.
TABLE-US-00001 EVLP time (min) 60 120 180 240 300 Breathing 10 10
10 10 10 frequency/min PEEP (cmH2O) 5 5 5 5 5 Peak airway pressure
25 25 25 25 25 (cmH2O) FiO2 (%) 100 100 100 100 100 Flow (L/min)
2.0 2.0 2.0 2.0 2.0
[0046] The following parameters were continuously monitored and
registered every hour.
[0047] Left Atrium Pressure (LA-P mmHg), Left Atrium pH (LA-pH),
Left Atrium PO2 (LA-PO2 mmHg), Left Atrium temperature (LA-T
.degree. C.), Pulmonary Artery Pressure (PA-P mmHg), Pulmonary
Artery pH (PA-pH), Pulmonary Artery PO2 (PA-PO2 mmHg), Pulmonary
Artery Temperature (PA-T .degree. C.), Dynamic compliance (cdyn
ml/cmH2O) and Pulmonary Vascular Resistance (PVR
mmHg.times.min/L).
TABLE-US-00002 EVLP time (min) 60 120 180 240 300 LA-P (mmHg) 9 3 4
3 3 LA-pH Not Not Not 7.23 7.24 calibrated calibrated calibrated
LA-PO2 (mmHg) 219 353 464 450 457 LA-T (.degree. C.) 37.0 36.9 37.0
37.0 36.8 PA-P (mmHg) 21 14 15 15 15 PA-pH Not Not Not 7.02 7.00
calibrated calibrated calibrated PA-PO2 (mmHg) 49 77 138 114 114
PA-T (.degree. C.) 38.0 38.0 38.0 38.0 38.0 cdyn (ml/cmH2O) 46.3
31.9 30.2 31.4 29.9 PVR (mmHg .times. 436 440 440 473 473
min/L)
* * * * *